Type 2 diabetes imposes a heavy burden on public health in the United States. This burden falls disproportionately upon African Americans. The prevalence of type 2 diabetes is over 50% greater in African Americans than in whites, and African Americans are at even higher risk for severe diabetic complications including end-stage renal disease and lower extremity amputation. Possible causes of this excess risk in African Americans include inadequate access to optimal primary health care and suboptimal health behaviors. We are therefore conducting a randomized, controlled trial to test two primary-care-based interventions to reduce risk in diabetic African Americans: 1) a community outreach intervention and 2) a nurse case-manager intervention. We have recruited 186 African Americans with type 2 diabetes who reside in East Baltimore and receive primary health care from sites affiliated with Johns Hopkins and its internal medicine training program. Each participant has been assigned to one of four parallel arms: 1) usual care only, 2) usual care + community outreach, 3) usual care + nurse case-manager, and 4) usual care + community outreach + nurse case-manager. This project will determine whether culturally sensitive enhanced practice and/or community outreach interventions can produce and sustain improvements in glycemia, blood pressure, lipid levels, and weight over 36 months in a population of inner-city African Americans with type 2 diabetes. In doing so, it will provide the empiric basis for a primary-care-based strategy to control the epidemic of diabetic complications among inner-city African Americans. If successful, the one or both interventions could be exported to and adapted for primary practice sites serving African Americans in cities across the nation. Furthermore, the process of intervention development and validation could serve as a model for parallel efforts to improve the care of other U.S. minority groups who suffer high rates type 2 diabetes and its complications. The support of the Johns Hopkins OPD-GCRC continues to be absolutely crucial to the success of this project. It provides space and a staff for all screening and data collection visits. It also supports laboratory analyses, data entry, and data processing.